Healthcare Provider Details

I. General information

NPI: 1518689033
Provider Name (Legal Business Name): ERIC LAO PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9311 SE 36TH ST STE 120
MERCER ISLAND WA
98040-3741
US

IV. Provider business mailing address

9311 SE 36TH ST STE 120
MERCER ISLAND WA
98040-3741
US

V. Phone/Fax

Practice location:
  • Phone: 206-312-5373
  • Fax:
Mailing address:
  • Phone: 206-312-5373
  • Fax: 800-259-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN61072737
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61686791
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: